Journal Article > ReviewFull Text
Lancet Global Health. 2021 May 1; Volume 9 (Issue 5); e681-e690.; DOI:10.1016/S2214-109X(20)30539-8
Park JS, Grais RF, Taljaard M, Nakimuli-Mpungu E, Jehan F, et al.
Lancet Global Health. 2021 May 1; Volume 9 (Issue 5); e681-e690.; DOI:10.1016/S2214-109X(20)30539-8
This paper shows the scale of global health research and the context in which we frame the subsequent papers in the Series. In this Series paper, we provide a historical perspective on clinical trial research by revisiting the 1948 streptomycin trial for pulmonary tuberculosis, which was the first documented randomised clinical trial in the English language, and we discuss its close connection with global health. We describe the current state of clinical trial research globally by providing an overview of clinical trials that have been registered in the WHO International Clinical Trial Registry since 2010. We discuss challenges with current trial planning and designs that are often used in clinical trial research undertaken in low-income and middle-income countries, as an overview of the global health trials landscape. Finally, we discuss the importance of collaborative work in global health research towards generating sustainable and culturally appropriate research environments.
Journal Article > ResearchFull Text
Lancet. 2009 June 6; Volume 373 (Issue 9679); DOI:10.1016/S0140-6736(09)60231-2
Palmer A, Tomkinson J, Phung C, Ford NP, Joffres M, et al.
Lancet. 2009 June 6; Volume 373 (Issue 9679); DOI:10.1016/S0140-6736(09)60231-2
Human-rights treaties indicate a country's commitment to human rights. Here, we assess whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less wealthy settings, but this was not associated with treaty ratification. The status of treaty ratification alone is not a good indicator of the realisation of the right to health. We suggest the need for stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states with treaty obligations, and financial assistance to support the realisation of the right to health.
Journal Article > Meta-AnalysisFull Text
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Ford NP, Shubber Z, Meintjes GA, Grinsztejn B, Eholie SP, et al.
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Journal Article > CommentaryFull Text
Clin Infect Dis. 2012 March 19; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Ford NP, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T, et al.
Clin Infect Dis. 2012 March 19; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Journal Article > CommentaryFull Text
AIDS. 2010 January 28; Volume 24 (Issue 3); DOI:10.1097/QAD.0b013e3283357e0f
Mills EJ, Ford NP, Nabiryo C, Cooper C, Montaner JSG
AIDS. 2010 January 28; Volume 24 (Issue 3); DOI:10.1097/QAD.0b013e3283357e0f
Journal Article > CommentaryFull Text
Humanitarian Practice Network. 2007 December 1; Volume 61
Checchi F, Gayer M, Grais RF, Mills EJ
Humanitarian Practice Network. 2007 December 1; Volume 61
Journal Article > ReviewFull Text
Curr HIV/AIDS Rep. 2016 July 30; Volume 13 (Issue 5); 241-255.; DOI:10.1007/s11904-016-0325-9
Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, et al.
Curr HIV/AIDS Rep. 2016 July 30; Volume 13 (Issue 5); 241-255.; DOI:10.1007/s11904-016-0325-9
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N?=?97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR?=?1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR?=?1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR?=?0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR?=?1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR?=?1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.
Journal Article > CommentaryFull Text
Lancet. 2009 July 25; Volume 374 (Issue 9686); 275-276.; DOI:10.1016/S0140-6736(09)61348-9
Mills EJ, Ford NP, Mugyenyi P
Lancet. 2009 July 25; Volume 374 (Issue 9686); 275-276.; DOI:10.1016/S0140-6736(09)61348-9
Journal Article > Meta-AnalysisFull Text
AIDS. 2012 May 15; Volume 26 (Issue 8); DOI:10.1097/QAD.0b013e328351f5b2
Ajose O, Mookerjee S, Mills EJ, Boulle AM, Ford NP
AIDS. 2012 May 15; Volume 26 (Issue 8); DOI:10.1097/QAD.0b013e328351f5b2
A growing proportion of patients on antiretroviral therapy in resource-limited settings have switched to second-line regimens. We carried out a systematic review in order to summarize reported rates and reasons for virological failure among people on second-line therapy in resource-limited settings.
Journal Article > ReviewFull Text
Clin Infect Dis. 2013 July 29; Volume 57 (Issue 9); 1351-1361.; DOI:10.1093/cid/cit494
Ford NP, Shubber Z, Saranchuk P, Pathai S, Durier N, et al.
Clin Infect Dis. 2013 July 29; Volume 57 (Issue 9); 1351-1361.; DOI:10.1093/cid/cit494
BACKGROUND
Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings.
METHODS
We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients.
RESULTS
We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%).
CONCLUSIONS
Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.
Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings.
METHODS
We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients.
RESULTS
We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%).
CONCLUSIONS
Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.